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06/12/2002 Archived Entry: "Round two - update two"
Dr. Lewis showed up around 7:45 Wednesday morning to do a sonogram. He started off by looking at the baby's chest area, and was happy to see that the fluid had not re-accumulated. He showed us the catheter in her chest and the small pocket of fluid around it. The lungs looked good. The CCAMs are still visible, but the fact that the lung was still expanded was VERY encouraging.
He then spent a lot of time looking at the baby's abdomen, and noted that the ascites, while smaller, were still present. He also measured Chrissy's level of amniotic fluid. Previously, the amount of amniotic fluid in her uterus had been quite high (AFI of circa 28 cm before the first procedure), but today, it was reading at 8 cm.
Because ultrasounds are two dimensional, and because babies move so much, it is difficult to measure three-dimensional volumes (of say, liquid), so what they do in the case of amniotic fluid is divide the uterus into four quadrants, and measure the longest distance of the patches of visible amniotic fluid. The four measurements are then added up to provide the AFI (amniotic fluid index).
According to this page, the AFI should range between 8 and 25. Previously, we were HIGHER than the “normal” range, and now we are at the LOWER end of the “normal” range. I suspect that the AFI is supposed to remain relatively constant during pregnancy with gradual variations and should not jump so wildly in a couple of weeks.
The concern is that the lack of amniotic fluid will cause pressure on the umbilical cord, which can cause heart failure. One of the symptoms of heart problems is the development of ascites. There do not appear to be any other indications of heart problems other than the ascites, and her heart appears to be beating fine. Dr. Lewis said that he would be back on Friday to run another sonogram.
We asked what the implications of this were, and how much longer Chrissy would have to stay. Dr. Lewis said that unfortunately, because there is a risk of heart failure, they would need to intervene very quickly if the baby’s heart rate suddenly dropped, and therefore her heart rate would have to be monitored constantly. This means that Chrissy will have to remain at the hospital possibly for the remainder of this pregnancy. They will probably perform an amniocenteses at 35 weeks (5 weeks from now) to get a feel for how the baby’s lung development is progressing.
We are pretty stressed about this for many reasons. The prospect of spending 10 weeks in bed rest is not appealing, nor is the probability that she would have to be moved down to the Maternity ward on the second floor into a shared room.
In other news, the hospital food is of the expected quality, and the hospital chef’s vegetarian range seems to be limited to a starch accompanied by a few heated canned vegetables. Luckily, she is NOT on any sort of restricted diet, so we are likely going to have to supplement her diet with home-brought foods.
Physically, Chrissy is feeling MUCH better today. Her contractions have dropped from a high of seven or eight per hour to zero per hour, so they have taken her off the magnesium sulfate, and she is now taking Nifedipine (Procardia). She has managed to keep food down several times (though her appetite is not quite back to its pre-procedure levels yet), and she is now allowed to go the bathroom again, but she isn’t allowed out of bed for any other reason.
I'll try to update again on Friday after the next sonogram.